BTECH Certificate Request Form

BTECH Certificate Request Form
- Processing time for certificates is 3 to 5 business days
- Certificates are $5 per copy - due with request
- Certificates are sent via USPS or can be picked up from BTECH, there are no digital copies at this time.
- All tuition/fees must be paid in full
Personal Information
Full Legal Name:

First NameMiddle NameLast Name
Maiden Name:
Last Name
BTECH Student ID (if known):
Last 4 digits of SSN
Birthdate

MonthDayYear
I am requesting this transcript for:
If you are a current high school student enrolled in a public school your BTECH high school credit will be reflected on your home high school transcript. Contact your home high school for more information. You do not need to complete this transcript request.

If you are a homeschool or out-of-state student, continue with the request.
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Can we update your information if it is different from what is currently in our system?

Recipient Information
Delivery Method:
Recipient's Name
Recipient's Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Do you need a file attached with your transcript? (Transcript Matching Form, etc.)
Upload file here:

Cancelof
Authorized person to pick-up your certificate if not yourself:
Picture ID is required at time of pick-up.
Email (Unofficial transcripts only)
If different from the one entered above.
BTECH Department Name
Fax - : (Institution name, attention to, fax number, etc.) - Unofficial ONLY
Do you need an additional address?
2nd Recipient Name
2nd Recipient Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Comments:

Certficate

Enter description

$5.00 Quantity

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Release and Notification
RELEASE ACKNOWLEDGEMENT: I authorize the release of my academic records to the third parties specified on this form. I also approve the delivery method indicated above.
Signature:
Date:

MonthDayYear
How would you like to be notified that your request has been completed/is ready for pick up?
Should be Empty:

Personal Information